Let’s face it: HMOs and PPOs are playing a game of bait and switch, keeping monthly premium increases down while raising their members’ out-of-pocket costs.
The Avalere health consulting firm reports that specialty drug costs are no exception, with more than four out of 10 state health exchange “silver” plans and more than half of the “bronze” plans requiring members to pay at least 30 percent of their cost in 2015. For many people with life-threatening illnesses who rely on these expensive drugs, this jeopardizes treatment. (And, costs for critical generic drugs also can be prohibitive.)
The health plans are culpable mainly because they would rather shift costs to their members than admit they are powerless to contain prices. Consequently, they won’t join forces with their members and call upon Congress to ensure drug prices are reasonable. They won’t risk getting on the wrong side of lawmakers who are beholden to the drug industry. They do this knowing full well how important drugs can be for people with cancer, multiple sclerosis and myriad other complex conditions—and that high coinsurance could be a death sentence for those who can’t afford it.
It is a gross injustice for Congress to allow health plans to leave people with serious and disabling conditions at the mercy of out-of-control drug costs rather than rein in prices, as every other industrialized nation does. People need to be able to budget for their care up front. Their premiums should be seen as ample contribution to the cost. Insured people should not be forced to go without critical medications.
Of course, when you follow the money and the lobbyists, as the Center for Responsive Politics and Pro Publica have done, you see very quickly why Congress supports what’s best for the pharmaceutical industry, not ordinary Americans.